by Mike Andrew -
SGN Staff Writer
China has slashed AIDS mortality by nearly two thirds since it began distributing free antiretroviral drugs in 2002, Chinese government scientists said May 18.
But a joint study by the International Labor Organization (ILO) and China's Center for Disease Control and Prevention (CDC) published the same day says that anti-AIDS bias often prevents HIV-positive Chinese from finding or keeping jobs.
The study on AIDS mortality was published online by The Lancet, a weekly medical journal with offices in London, New York, and Beijing,
According to the Lancet article, 63% of all Chinese who need anti-AIDS drugs are now getting them, up from virtually zero in 2002.
That has caused a 64% drop in mortality in 'person-years,' as China measures disease mortality. The measurement is an estimate of how long someone would have lived without the disease.
According to the report, AIDS mortality dropped to 14.2 per 100 person-years in 2009, down from 39.3 in 2002.
The study attributed this stunning improvement to distribution of free anti-retroviral medications to all eligible HIV-positive Chinese, as part of the country's national heath care system.
China's success 'is a testimony to the young midlevel scientists who convinced the leadership that this was the right thing to do,' said Dr. Myron Cohen, an AIDS specialist from the University of North Carolina who has lived in China and helped it battle the epidemic.
China currently begins treatment when a patient's CD4 cell count, a measure of immune system strength, drops below 350 per cubic millimeter.
Chinese officials are now debating whether to start treatment as soon as a patient tests positive for HIV, Dr. Cohen said.
A previous study showed that this strategy, known as 'treatment as prevention,' could reduce new HIV infections by up to 96% by reducing the risk to an infected person's sexual partners.
At the same time, the Lancet report was critical of China's health care providers, saying that bias against HIV/AIDS patients resulted in a lower standard of care.
Based on interviews with patients, health care workers, and hospital managers, the report says that HIV/AIDS patients are frequently turned away by hospitals.
AIDS patients are regularly sent by general hospitals to infectious-disease hospitals, but the specialty hospitals often refuse to provide a full range of treatments for AIDS patients.
Hospitals often refuse to perform surgery on HIV/AIDS patients, the report charges, for fear that paying patients will avoid the hospital if word spreads that it operates on AIDS patients.
In its report, the ILO also referred to anti-AIDS bias, saying that HIV-positive Chinese are targeted for discrimination in employment.
In their report titled HIV and AIDS Related Employment Discrimination in China, the ILO and China's CDC noted a wide range of national laws and regulations that prevent HIV-positive people from getting jobs.
National policy for recruiting civil servants, for example, specifies that 'those who suffer gonorrhea, syphilis, chanchroid, venereal lymphogranuloma, HPV, genital herpes or HIV will be disqualified.'
A similarly worded guideline applies to police employment.
Sanitation guidelines forbid those with HIV/AIDS and other sexually transmitted infections from working in public places such as bars, hotels, restaurants, beauty salons, and hairdressers.
The ILO report also cites mandatory HIV testing of Chinese workers, and cases in which HIV-positive individuals have been denied employment, been forced to resign from their jobs, or been demoted.
All of these practices are contrary to the ILO Code of Practice on HIV/AIDS, adopted in 2001, of which China is a signatory.
The number of HIV-positive people in China is estimated by UNAIDS to be around 740,000.
While large in comparison with most countries, the number is relatively small in a total population of 1.3 billion.
Of those believed to be HIV-positive, 323,252 have been tested and 82,540 are being treated.
If the total caseload estimate is correct, China has tested somewhat less than half its infected people. By comparison, the United States estimates that some 80% of its 1.1 million infected people have been tested.
In spite of its shortcomings, China has made significant progress in dealing with HIV/AIDS in the past 20 years.
As late as 1990, China's education ministry promoted 'sexual morality and self-discipline' as the main method of AIDS prevention.
Imports of blood products were also banned and foreigners were required to take blood tests.
Police barred foreigners from dance halls and took other steps to prevent sex between Chinese and outsiders.
In 1999, China's first condom ad was banned as offensive a mere two days after it was released.
In 2001, however, the government launched a major policy shift.
Chinese officials publicly admitted that 500,000 to one million people were infected and asked for outside help.
Condoms were reclassified as 'safety devices.' At the same time, China said that if Western drug companies did not lower their prices, it would make antiretroviral drugs itself.
In 2002, China applied for $90 million from the Global Fund to Fight AIDS, Tuberculosis, and Malaria to begin its free drugs program.
In return, it was forced to free an AIDS activist who had been imprisoned after posting details of unsanitary sales of blood in Henan Province.
In December 2003, Premier Wen Jiabao publicly shook hands with AIDS patients, in a symbolic repudiation of anti-AIDS prejudice.
'You must have the confidence to overcome the disease, for you will have love and care from the entire society,' Wen promised at the time.
China's biggest treatment success has been among former plasma sellers.
In the 1990s, tens of thousands of poor farmers sold plasma to commercial operations as a way to get cash.
The reinfusion process, which is standard in plasma donation, allowed HIV to spread rapidly among donors. Soon, in some rural villages, half the adults were infected.
Many of the early victims died before 2002, but among the survivors, 80% are now getting antiretroviral drugs.
By contrast, the figure for those infected through sex is about 60%. For those infected by injecting drugs, it is about 40%.
Infection through sex is most common among Gay men and customers of prostitutes.
In 2010, China estimated that 85% of female prostitutes used condoms. Other studies suggest that fewer than 1% are infected, but high-risk sex is common enough for infections to continue.
Figures on Gay men are more difficult to obtain, since many still keep their sexual orientation secret in deference to social and family expectations.
China offers free needles and methadone to addicts, drawing many in to be tested for AIDS.
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